Photo by the author. Namanatai, Papua New Guinea
[This article has been published in Spanish in El País-Planeta Futuro]
In this series of articles, Camila describes the daily routine of an ISGlobal team working to eliminate yaws in the island district of Namatanai in Papua New Guinea. The following is the second chapter:
17 January, 2019, Namatanai
To achieve our goal of eliminating yaws from this island, we need to mount a large and complex logistical operation involving over 200 people on the ground. And here in Papua New Guinea every small logistical task has the potential to become a minor Greek drama. We joke that 90% of our work is related to solving the problems that are preventing us from getting our work done. The point is that, at the moment, we are in standby mode until the filariasis team can start.
Delays are nothing new in Papua and usually they would not be a major problem, but we are already two months behind schedule on the project due to an epidemic in this province of polio (yes, that disease which has almost been eradicated). Before we could start our work, we had to wait for the polio vaccination campaign to be completed. Consequently, we spent almost three months in Papua New Guinea working on logistics—time that was certainly needed— while routinely receiving news of delays that would extend the vaccination campaign by “just one more week”.
To achieve our goal of eliminating yaws from this island, we need to mount a large and complex logistical operation involving over 200 people on the ground
We spent last week preparing and training the community health workers—the first phase in the implementation of any public health campaign. They will be in charge of the teams in each ward and responsible for collecting the data and administering the drugs in the villages in the area assigned to them. These health workers have been trained how to detect and treat yaws. They have also received training on how to collect data and to use cell phones to record geographical coordinates and enter data electronically, as well as many other tasks that have to be done in the field.
There are 38 wards in Namatanai, spread over an area of the island some 200 kilometres long and about 15 kilometres wide. We have trained 38 teams (one per ward), each comprising five to nine members depending on the size of the population in the ward. We have 17 vehicles to transport all the teams and the five supervisors, including the three of us. Our goal is to treat all of the more than 50,000 people who live in Namatanai. We will repeat the treatment every six months for two years to eliminate yaws from the island. The reason why everyone must be treated is that the disease is highly infectious and up to 20% of the population may have a latent infection. Therefore, when we detect a symptomatic case of yaws (a person who has an ulcer produced by the bacteria) the patient has probably already infected family members or schoolmates.
Our goal is to treat all of the more than 50,000 people who live in Namatanai. We will repeat the treatment every six months for two years to eliminate yaws from the island
This is a titanic task, but we’re doing pretty well so far! In the first round of mass administration of the yaws treatment in May 2018, we achieved general coverage (the percentage of the population who received treatment) of 84% (70%-92%). However, we need to reach over 90% of the population to eliminate the disease from this community. However, the challenge of impossible roads and villages buried deep in the jungle makes it hard to reach the desired coverage level. Fortunately, we have marvellous people on our team, who are helping us to reach the most remote areas of the island.
Finally, the call comes with the news that the filariasis team is ready to start. We spend the day on final preparations and advise all the teams and vehicles that we will start visiting the villages in the 38 wards simultaneously on the following day to implement the mass administration of the drugs for both yaws and filariasis. At last!
Fieldwork and implementation is undoubtedly the best part of research and health programmes—all the months (or years) of preparation and scientific, bureaucratic, and logistical work culminate in a few days of implementation. Having all the details under control and everything prepared on time is crucial.
Diary of a Researcher in Papua New Guinea (1). The Island with the Sky of a Thousand Colours
Diary of a Researcher in Papua New Guinea (3). In the Shade of a Tree